DSM: erectile disorder (men) Flashcards
(6 cards)
criteria erectile disorder
Criteria
A. At least one of the three following symptoms must be experienced on almost all or all (approximately 75%–100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):
1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of sexual activity.
3. Marked decrease in erectile rigidity.
B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in the individual.
D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
Specify whether:
- Lifelong: The disturbance has been present since the individual became sexually active.
- Acquired: The disturbance began after a period of relatively normal sexual function.
Specify whether:
- Generalized: Not limited to certain types of stimulation, situations, or partners.
- Situational: Only occurs with certain types of stimulation, situations, or partners.
Specify current severity:
- Mild: Evidence of mild distress over the symptoms in Criterion A.
- Moderate: Evidence of moderate distress over the symptoms in Criterion A.
- Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.
Associated features supporting diagnosis
Many men with erectile disorder may have low self-esteem, low self-confidence, and a decreased sense of masculinity, and may experience depressed affect. Fear and/or avoidance of future sexual encounters may occur. Decreased sexual satisfaction and reduced sexual desire in the individual’s partner are common.
With specifying, look at partner, relationship, individual vulnerability, psychiatric comorbidity, stressors, culture/religion, and medical factors.
prevalence
Prevalence
The prevalence of lifelong versus acquired erectile disorder is unknown. There is a strong age-related increase in both prevalence and incidence of problems with erection, particularly after age 50 years. Approximately 13%–21% of men ages 40–80 years complain of occasional problems with erections. Approximately 2% of men younger than age 40–50 years complain of frequent problems with erections, whereas 40%–50% of men older than 60–70 years may have significant problems with erections. About 20% of men fear erectile problems on their first sexual experience, whereas approximately 8% experienced erectile problems that hindered penetration during their first sexual experience.
development and course
Development and course
Erectile failure on first sexual attempt has been found to be related to having sex with a previously unknown partner, concomitant use of drugs or alcohol, not wanting to have sex, and peer pressure. Often they spontaneously remit, episodic problems. Lifelong is unknown. Distress associated with erectile disorder is lower in older men as compared with younger men.
risico, cultuur en functionele consequenties
Risk and prognostic factors
Temperamental. Neurotic personality traits may be associated with erectile problems in college students, and submissive personality traits may be associated with erectile problems in men age 40 years and older. Alexithymia (i.e., deficits in cognitive processing of emotions) is common in men diagnosed with “psychogenic” erectile dysfunction. Erectile problems are common in men diagnosed with depression and posttraumatic stress disorder.
Course modifiers. Risk factors for acquired erectile disorder include age, smoking tobacco, lack of physical exercise, diabetes, and decreased desire.
Culture-related diagnostic issues
Complaints of erectile disorder have been found to vary across countries. It is unclear to what extent these differences represent differences in cultural expectations as opposed to genuine differences in the frequency of erectile failure.
Functional consequences of erectile disorder
Erectile disorder can interfere with fertility and produce both individual and interpersonal distress. Fear and/or avoidance of sexual encounters may interfere with the ability to develop intimate relationships.
differential diagnose en comorbiditeit
Differential diagnosis
- Non-sexual mental disorders;
- Normale erectile function;
- Substance use/medication;
- Another medical condition;
- Other sexual dysfunctions.
Comorbidity
Erectile disorder can be comorbid with other sexual diagnoses, such as premature (early) ejaculation and male hypoactive sexual desire disorder, as well as with anxiety and depressive disorders. Erectile disorder is common in men with lower urinary tract symptoms related to prostatic hypertrophy.
Erectile disorder may be comorbid with dyslipidemia, cardiovascular disease, hypogonadism, multiple sclerosis, diabetes mellitus, and other diseases that interfere with the vascular, neurological, or endocrine function necessary for normal erectile function.
